Personality Disorders

Question 1

What are 3 important personality theories?

Answer 1

Personality Theory

 Sigmund Freud
o Psychoanalysis – bringing the unconscious conscious

o Structure of personality - Id, ego, superego

o Defense mechanisms

 Erik Erikson
o Stages of Psychosocial Development

 The Big Five

Question 2

Describe each of Erikson’s stages of psychosocial development.

Answer 2

 Infancy (0-1yo)

o Conflict = basic trust vs. mistrust
o Resolution or “Virtue” = hope
o Culmination in Old Age = appreciation of interdependence and relatedness

 Early Childhood (1-3yo)
o Conflict = autonomy vs. shame
o Resolution or “Virtue” = will
o Culmination in Old Age = acceptance of the cycle of life, from integration to disintegration

 Play Age (3-6yo)
o Conflict = initiative vs. guilt
o Resolution or “Virtue” = purpose
o Culmination in Old Age = humor; empathy; resilience

 School Age (6-12yo)
o Conflict = industry vs. inferiority
o Resolution or “Virtue” = competence
o Culmination in Old Age = humility; acceptance of the course of one’s life and unfulfilled hopes

 Adolescence (12-19yo)
o Conflict = identity vs. confusion
o Resolution or “Virtue” = fidelity
o Culmination in Old Age = sense of complexity of life; merging of sensory, logical, and aesthetic perception

 Early Adulthood (20-25yo)
o Conflict = intimacy vs. isolation
o Resolution or “Virtue” = love
o Culmination in Old Age = sense of the complexity of relationships; value of tenderness and loving freely

 Adulthood (26-64yo)
o Conflict = generativity vs. stagnation
o Resolution or “Virtue” = care
o Culmination in Old Age = caritas, caring for others, and agape, empathy and concern

 Old Age (64-death)
o Conflict = integrity vs. despair
o Resolution or “Virtue” = wisdom
o Culmination in Old Age = existential identity; a sense of integrity strong enough to withstand physical disintegration

Question 3

What is the big five?

Answer 3

 Personality is a relatively enduring style of experiencing oneself and relating to others

o Neuroticism vs. Emotional Stability 
o Extraversion (Surgency)
o Openness vs. Conventional/Conservative
o Agreeableness vs. Antagonism
o Conscientiousness (Will to Achieve)

Question 4

Define personality disorder.

Answer 4

Enduring subjective experiences and behaviors that deviate from cultural standards, are rigidly

pervasive, have an onset during adolescence or early adulthood, are stable over time, and lead to

functional impairment or subjective distress

Question 5

How does DSM-V define a personality disorder?

Answer 5

 An enduring pattern of inner experience and behavior that deviates markedly from the expectations of one’s culture, manifesting in 2 or more ways:

o Cognition

o Affectivity

o Interpersonal function

o Impulse control

 The enduring pattern is inflexible and pervasive across a broad range of situations

 Leads to clinically significant distress or impairment

 The pattern is stable and long duration dates back to at least adolescence

 Not better explained by another mental disorder

 Not attributable to physiological effects of substance or medical condition

Question 6

What is the prevalence of PD in the general population? How many psychiatric patients have a PD? In what way are PD related to other psychiatric disorders and what is the clinical effect of this?

Answer 6

 Prevalence is estimated b/w 10-20% of general population

 Approximately ½ of psychiatric patients have a PD

 PD is also predisposing factor for other psychiatric disorders which can in turn impact treatment efficacy and increase morbidity and mortality in these patients

Question 7

What are the 3 clusters of PD and what PD are included in each?

Answer 7

 Cluster A 
o Schizotypal
o Schizoid
o Paranoid 
o 

 Cluster B 
o Narcissistic 
o Borderline 
o Antisocial 
o Histrionic 

 Cluster C
o Obsessive compulsive
o Dependent
o Avoidant

Question 8

Explain 6 possible etiologies of PDs.

Answer 8

 Genetics
o 15,000 MZ twins examined in the US concordance rate was several times higher than in the general population

 Hormones
o Impulsive traits have been linked with higher levels of testosterone, 17-estradiol, and estrone

 Monoamines
o Low MAOs have been linked with decreased sociability

 Neurotransmitters
o Raising serotonin has been linked with decrease in depression, impulsiveness, and rumination

 Electrophysiology
o Slow wave EEG activity in antisocial and borderline type

 Smooth eye pursuits are saccadic in introverted people

Question 9

Explain the psychoanalytic factors concerning PDs.

Answer 9

Psychoanalytic Factors

 Personality traits are related to what sexual development stage an individual has a fixation

 Characteristic defense mechanisms keep PD traits ego dystonic

o Fantasy, dissociation, isolation, projection, splitting, passive aggression, acting out

Question 10

What are the epidemiology, clinical features, and treatment of Paranoid PD?

Answer 10

Paranoid PD (cluster A)

 Epidemiology
o 0.5 to 2.5% of general population
o More common in males

 Clinical Features
o Excessive mistrust of others
o Tendency to interpret others as being deliberately threatening

 Treatment
o Psychotherapy is the treatment of choice
o Antianxiety medications&raquo_space; diazepam (Valium) prn or in some cases haloperidol (Haldol)

Question 11

What are the epidemiology, clinical features, and treatment of Schizoid PD?

Answer 11

 Epidemiology
o 7.5% of general population
o ? More common in males

 Clinical Features
o Life-long pattern of social withdrawal
o Rarely tolerate eye contact, may appear ill at ease

 Treatment
o Psychotherapy
o Small dose of antipsychotics, antidepressants, and stimulants

Question 12

What are the epidemiology, clinical features, and treatment of Schizotypal PD?

Answer 12

 Epidemiology
o 3% of general population

 Clinical Features
o Disturbed thinking and communication
o Reduced social capacity plus perceptual distortions or behavioral eccentricities

 Treatment
o Psychotherapy
o Antipsychotics for ideas of reference (TV commercial is just for me) & illusions (misperception or misinterpretation of a real external stimulus, such as hearing the rustling of leaves as the sound of voices)

Question 13

What are the epidemiology, clinical features, and treatment of antisocial PD?

Answer 13

 Epidemiology
o 3% of males 1% of females

 Clinical Features
o Pervasive pattern of violating the rights of others

 Treatment
o Psychotherapy
o Meds often used to deal with the accompanying symptoms

Question 14

Describe psychopathy.

Answer 14

Psychopathy
 Perhaps the single best predictor of violence (Melton et al. 2007)

 Best conceived as a constellation of traits:
o Egocentricity
o Irresponsibility
o Shallow emotions
o Lack of empathy, guilt, remorse
o Pathological lying
o Manipulative
o Persistent violation of social norms, rules, expectations
o Hare Psychopathy Checklist-Revised (PCL-R)

Question 15

What are the epidemiology, clinical features, and treatment of borderline PD?

Answer 15

Borderline PD (cluster B)

 Epidemiology
o 1-2% of general population
o 2x more common in women

 Clinical Features
o Instability in interpersonal relationships and affect as well an impulsivity

 Treatment

o Psychotherapy (dialectical behavior therapy) 
o Antipsychotics, antidepressants, MAO inhibitors, benzos, anticonvulsants, SSRIs

Question 16

What are the epidemiology, clinical features, and treatment of histrionic PD?

Answer 16

Histrionic PD (cluster B)

 Epidemiology
o 2-3% of general population
o More frequent in females

 Clinical Features
o High degree of attention seeking
o Tendency to exaggerate their thoughts and feelings to sound more important
o Seductive behavior is common

 Treatment
o Primarily psychotherapy

Question 17

What are the epidemiology, clinical features, and treatment of narcissistic PD?

Answer 17

Narcissistic PD (cluster B) 
 Epidemiology
o 2-16% of clinical population 
o Less than 1% of general population 
 Clinical Features 
o Grandiose sense of self importance

 Treatment
o Psychotherapy
o Lithium has been used in patients with co-occurring mood swings

Question 18

What are the epidemiology, clinical features, and treatment of avoidant PD?

Answer 18

 Epidemiology
o 1-10% of general population

 Clinical Features
o Central feature is hypersensitivity to rejection
 this persons desire companionship, but justify avoidance by fear of rejection (diff from schizoid)

 Treatment
o Psychotherapy
o Meds to manage co-occurring anxiety and depression, atenolol can help with autonomic hyperactivity

Question 19

What are the epidemiology, clinical features, and treatment of dependent PD?

Answer 19

 Epidemiology
o 2.5% of all diagnosed personality disorder
o More common in females

 Clinical Features
o Pervasive pattern of submissive and dependent behavior

 Treatment
o Psychotherapy
o Meds for co-morbid depression and anxiety symptoms

Question 20

What are the epidemiology, clinical features, and treatment of OC PD?

Answer 20

 Epidemiology
o unknown

 Clinical Features
o Pre-occupation with rules, regulations, orderliness, neatness, details, and need for perfection

 Treatment
o Psychotherapy
o Meds such as clonazepam and SSRIs

Question 21

What is PD NOS?

Answer 21

 Passive Aggressive

 Depressive

 Basically enduring patterns that do not fit into the other categories

 A narrow spectrum of behavior or trait
o Oppositionalism, sadism, masochism

Question 22

What are 4 reasons to do psych testing?

Answer 22

Why Psychological Testing?

 Aid in diagnostic clarification

 Help determine which treatment intervention can be most beneficial

 Detection of subtle psychosis

 Monitoring the severity of symptoms over time and treatment

Question 23

What are some  Common Objective Psychological Testing Instruments and what are they like?

Answer 23

o Minnesota Multiphasic Personality Inventory (MMPI-2)

o Millon Clinical Multiaxial Inventory (MCMI-3)

o Objective, self-report measures with built in validity checks

Question 24

What are some  Common Projective Psychological Test Instruments and what are they like?

Answer 24

o Rorschach Psychodiagnostic Inkblot Test

o Thematic Apperception Test (TAT)

o Draw-a-Person

o Sentence Completion Measures

Question 25

What are some common rating scales?

Answer 25

 Common Rating Scales 
o Depression
 Beck Depression Inventory 
 Beck Hopelessness Scale 
 Geriatric Depression Scale 

o Anxiety
 State-Trait Anxiety Inventory
 Beck Anxiety Inventory